Smoking

Introduction

Smoking causes more than 120,000 deaths each year in the UK
Smoking is the largest single preventable cause of death
Smoking accounts for more than one third of deaths in middle age
Smoking costs the NHS more than £1500 million annually
Smoking causes an estimated 50 million working days lost through sickness absence
27% of smokers are concentrated in the lowest 10% income group

In 1996 adult smoking rates in Britain rose for the first time since the 1970’s. Stronger Government policy measures to control the use of tobacco, prevent children from starting to smoke and help smokers to give up are urgently required. In December 1998 the Government in its White Paper on tobacco - "Smoking Kills" - sets out a wide range policy measure to re-establish the downward trend in adult smoking. Particular targets are children, young people, pregnant women and working class smokers.

Aim

We think it is appropriate at such a time of national awareness that an attempt is made to identify the smoking habits of patients in this practice, motivate them to try and stop and encourage children, teenagers and non-smokers not to start.

Objectives

To initially search our computer records for those patients with a smoking history.
To opportunistically record the smoking habits of the remainder over a period of six months.
To advise all smokers to stop.
To assist smokers to stop
To arrange follow up

Recording of smoking habits will be achieved by:

General practitioner consultations
Nurse practitioner consultations
Practice nurse consultations and encounters
District nurse consultations and encounters
Midwife/antenatal encounters
Health visitor consultations and encounters
Patient questionnaires in waiting rooms

Smokers will be encouraged to quit by alerting them to:

Health risks
Financial implications
Risks of passive smoking

This will be done opportunistically and at organised "Stop Smoking Clinics"

Protocol for clinics

Use Smoking cessation Sophie

Smoking history in Adult screening current problem, but create new problem Health admin: smoking and note Refer to smoking cessation clinic if appropriate (use Sophie).
Initial visit – identify:
Smoking habits
Current concerns about smoking
Interest in trying to stop
Previous attempts and reasons for failure

Smokers not ready to quit

Explain about concerns for health and wellbeing
Offer a leaflet on stopping smoking (see motivation cycle ).

Smokers ready to quit

Provide appropriate advice and support, eg keep a smokers diary
Make self reward list
Identify crucial smokes
Identify "difficult social situations"
Identify supportive people
Advice on bupoprion and nicotine replacement therapy
Set a "Quit Smoking" day
Review visits (at negotiated intervals depending on individual)

Still smoking

Evaluate difficult times/lapses
Motivation
Partner/friend/workmate smoking
Encourage to try again

Stopped smoking

Reinforce heath and financial benefits
Continue to encourage
Change marker on computer from "smoker" to "ex-smoker" if continued abstinence

Evaluation

After a further six months search our computer records for percentage change in smoking habits. This will be repeated on a six monthly indefinite basis and fed back to the Primary Health Care Team for evaluation and assessment.

Audit standard

70% of patients over 15 will have a computer record of smoking history.

Resources

Staff time for preparation and evaluation of patient questionnaires
Increased general practitioner and nurse consultations
Involvement in local health promotion activities
Audit assistant time
Preparation and distribution of no-smoking posters and stop smoking leaflets.

Summary

The above proposal reflects our determination to be pro-active in motivating our patients to try and stop smoking and to encourage children, teenagers and non-smokers not to start. We will contribute a local strategy to tackle smoking as suggested by the Government’s recent White Paper – "Smoking Kills".

Sources

Department of Health: Smoking Kills: A White Paper on Tobacco London Stationery Office 1998
Raw M. McNeill A, West R: Smoking Cessation Guidelines for Health Professionals. A Guide to Effective Smoking Cessation Interventions for the Health Care System Thorax 1998

Development

Referrals may be made for patients who are ready to stop smoking for individual counselling.

Nicotine Replacement Therapy (Northumberland guidelines)